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Message from Dean Richardson: Envisioning a post-Flexner era for the next century

04/01/10 Portland, OR

Dear School of Medicine community:

In 1910, Abraham Flexner published what would become a set of highly influential recommendations titled Medical Education in the United States and Canada. His important report helped standardize medical training, laid the foundation for associating medical schools with research universities, and fostered the learning environment that has characterized academic medicine ever since.

One hundred years later, these recommendations are under renewed consideration. Darrell Kirch, MD, president of the Association of American Medical Colleges (AAMC), captured the core aspect of this scrutiny in a February 2010 article in Academic Medicine – in short, do the Flexner recommendations, and the individualistic, expert-centric culture to which they gave rise, now work against us as we seek to respond effectively to our rapidly changing external environment?

Earlier this month in Charleston, South Carolina, the AAMC Council of Deans met to continue our discussions on related topics. Comprised of the 132 medical school deans, the Council has been collaborating to create a "roadmap" for academic medicine designed to help lead medical schools successfully through the next century. In early 2009, the Council adopted eight principles. Taken together, their unifying theme is the idea that the strengths and attributes which allowed academic medicine to succeed in the past are not sufficient for the future. In other words, "What got us here, won't get us there."

Over the coming months, I'll be talking much more about these principles and the resulting reports from the workgroups. In the meantime, I want to share insights from two of the attending speakers who catalyzed interesting discussions at the meeting: Clayton Christensen and Francis Collins.

Clayton Christensen, MPhil, MBA, DBA, Professor, Harvard Business School, is internationally known for his academic work and is the author of five books, including the seminal 1997 work, "The Innovator's Dilemma." Dr. Christensen challenged us to consider if our century-old business and educational model is still relevant in the modern world. For example, the internet now supports patient access to diagnostic information and data that used to be the exclusive purview of physicians. Yet, across all medical schools, our educational models continue to emphasize individual diagnostic expertise – because that's how it's always been done. Dr. Christensen's historical research shows that successful entities that over-emphasize protecting the status quo in the face of a changing external environment tend to overlook innovative ways to recast their future. Worse, those innovations still inevitably occur because society wants them; they just occur elsewhere, outside of the status-quo institutions.

Francis Collins, MD, PhD, Director of the National Institutes of Health, also focused on the future and the NIH's goal of helping move the culture of individually based, highly competitive research toward the collaborative culture essential to successfully tackle the complex biomedical questions of our time. In addition to reinforcing the funding themes he recently discussed in the journal Science, Dr. Collins presented other possibilities including, for example, investing in centralized resources at the NIH campus – especially capital-intensive technologies – that would decrease competition for scarce resources across research institutions and thus better support collaboration.

The meeting was coordinated by the AAMC and I know the Council appreciated keeping the focus on the future of academic medicine in these fast-changing, post-Flexner times. What innovative strategies will we develop for all of our missions in the future and how will we allow those innovative strategies to succeed? These are the questions I asked myself, and will be asking you over the next few months.